Republic of the Philippines
PAMANTASAN NG LUNGSOD NG MAYNILA
(University of the City of Manila)
General Luna Street corner Muralla Street
Intramuros, Manila
COLLEGE OF NURSING
(Dalubhasaan ng Narsing)
INTENSIVE CARE NURSING – SKILLS CHECKLIST
DIRECT CURRENT DEFIBRILLATION FOR VENTRICULAR FIBRILLATION
PURPOSE:
Defibrillation is the use of electrical current, delivered in large amounts over a brief
period, to temporarily depolarized the heart so that when it repolarizes, it has a better chance of
resuming normal activity. It is use to terminate certain abnormal heart rhythm.
INDICATIONS:
Ventricular Fibrillation
Ventricular Tachycardia without a pulse
EQUIPMENT:
Direct current defibrillator with paddles
Interface material (disposable conducive gel pads, electrode gels and pastes)
Resuscitative Equipment
Implementation of the Procedure/Steps with Rationale
STEPS/PROCEDURE RATIONALE
Preparatory Phase:
1. Prepare the patient and the equipment
Emergency Cart with Defibrillator should
always on stand by
Performance Phase:
A. Unmonitored Patient
1. Check rhythm and pulse from an ECG or
cardiac monitor to confirm abnormal
rhythm
2. Expose anterior chest and remove jewelry
in the area
3. Start CPR immediately, while the 2nd
person gets the defibrillator
4. Check the defibrillator is on
unsynchronized mode
5. Apply interface material to the patient
(gel pads) or to the paddles (gel, pastes).
The electrode paddles should be in firm
contact with the patient’s skin.
6. Remove oxygen from immediate area.
7. A second person should turn on the
defibrillator to the prescribed setting.
Usually 120-200 joules for biphasic
defibrillator and 360 joules in monophasic
defibrillator (AHA recommends 360 joules)
8. Apply electrodes and/or paddles in 2
ways:
a. Anterolateral Position: Apply one
electrode just to the right of the upper
sternum below the clavicle and the other
electrode just to the left of the cardiac apex
or left nipple
b. Anteroposterior position: The anterior
paddle is held with pressure on the middle
of the sternum while the patient lies on the
posterior paddle under the left infrascapular
region
Caution: Paddles should be placed at least 5
inches away from a pacemaker
9. Grasp the paddles only by insulated
handles. Avoid any body contact to the
patient.
10. Charge the paddles. Once paddles are
charged, give the command for personnel to
stand clear of the patient and bed.
“Shockin’ on 3 & Oxygen out; One I’m
Clear, 2 You’re Clear, 3 Everyone is Clear!”
11.Discharge or Fire the shock by pushing
the discharge buttons on both paddles
simultaneously while placing about 22-25
pounds of pressure on each paddles
12. Remove paddles from the patient
immediately after the shock is administered
(unless the paddles are being used as
monitor leads)
13. Resume CPR efforts until stable rhythm,
spontaneous respirations, pulse, and BP
return
14. Look at the electrocardiograph monitor
to determine the specific therapy for the
resultant electrical mechanism. Continuous
high energy countershocks may be
necessary.
Performance Phase:
B. Monitored Patient
1. Assess rhythm and pulse from the cardiac
monitor
2. If pulseless Vtach or VF, Start CPR at
once, while someone is preparing the
defibrillator
3. Defibrillate patient as indicated
4. Analyze rhythm after each 5 cycles or 2
minutes of CPR
Follow-up Phase
1. After the patient is defibrillated and
rhythm is restored, antiarryhthmics are
usually given to prevent recurrent episodes
2. Document all interventions done to the
patient
3. Continue with intensive monitoring and
care
SCORE:
GRADING:
2 POINTS – Correct/Complete Rationale
1 POINT - Incomplete Rationale
0 POINT - Incorrect Rationale
TOTAL: 48 POINTS = 100% (Score / 48) x 100 = Score in Percentage
References:
Hudak,et al. Critical Care Nursing: A Holistic Approach
Schumacher & Chernecky. Critical Care and Emergency Nursing
Lippincott. Manual of Nursing Practice
Emergency Nurses Association of the Philippines. BLS & ACLS Handbook
Prepared By: Prof. Aris S. Santos, RN, RM, HAAD-RN, MSN-AHN
For AY 2023-2024, First Semester
Total score: _____________
I fully understand how I was graded for this skill and it was properly explained to me.
______________________________
Student’s FULLNAME & Signature
Date: ______________
I have explained and discussed how I have graded my student for this particular skill.
___________________________
Clinical Instructor FULLNAME & Signature
Date: _________
